Description: The essay discusses the appropriate role of insurance companies, efficient and economical ways to care for chronic illnesses and having a maximum price society will pay to support the ongoing life of any one individual.

Description: This essay highlights a view that many have for meeting these goals is one of a two-tiered system. The first tier in this system is a universal one controlled by the federal government, while the second tier is a private sector supplementing the first tier. The remainder of this paper will examine this two-tiered system and how various stakeholders in today’s system will be affected.

Description: Summary of results of a 2010 Health Section survey of actuaries and Medicare population, on ways to bend the cost trend curve downward. Issues included transparency, quality measures, fraud and abuse, provider payment, malpractice, medical errors, consumer education, and the pros and cons of employer-sponsored coverage.

Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: Susan Dentzer, editor-in-chief of Health Affairs, discusses health care and health policy.

Description: The article is a case study of various actuarial concepts invovled in the design and implementtion of the AQC - a global budget provider payment arrangement implemented by Blue Cross Blue Shield of MA.

Description: The entire issue of Health Watch.

Description: When setting reserves, multiple methods are often used in the creation of the reserve estimate. Judgment is warranted to combine these different estimates into a final recommendation. This paper describes two techniques that can be used to combine these estimates that may result in better accuracy and lower variance.

Description: Article describes enhanced primary care models and provides citations on whether or not health care savings have been achieved.

Description: This article discusses new opportunities for states to waive certain marketplace requirements of the Patient Protection and Affordable Care Act. The article focuses on specific opportunities for states and the role that actuaries will play.